Expert Consensus
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2020; 26(43): 6710-6769
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6710
First United Arab Emirates consensus on diagnosis and management of inflammatory bowel diseases: A 2020 Delphi consensus
Maryam Alkhatry, Ahmad Al-Rifai, Vito Annese, Filippos Georgopoulos, Ahmad N Jazzar, Ahmed M Khassouan, Zaher Koutoubi, Rahul Nathwani, Mazen S Taha, Jimmy K Limdi
Maryam Alkhatry, Gastroenterology and Endoscopy Department, Ibrahim Bin Hamad Obaid Allah Hospital, Ministry of Health and Prevention, Ras Al Khaiman, United Arab Emirates
Ahmad Al-Rifai, Department of Gastroenterology, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
Vito Annese, Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
Vito Annese, Department of Gastroenterology and Endoscopy, American Hospital, Dubai, United Arab Emirates
Filippos Georgopoulos, Gastroenterology and Endoscopy Unit, Al Zahra Hospital, Dubai, United Arab Emirates
Ahmad N Jazzar, Gastroenterology Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
Ahmed M Khassouan, Digestive Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
Zaher Koutoubi, Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
Rahul Nathwani, Department of Gastroenterology, Mediclinic City Hospital, Dubai, United Arab Emirates
Rahul Nathwani, Department of Gastroenterology, Mohammed Bin Rashid University, Dubai, United Arab Emirates
Mazen S Taha, Gastroenterology and Hepatology, Tawam Hospital, Al Ain, United Arab Emirates
Jimmy K Limdi, Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences, University of Manchester, Manchester M8 5RB, United Kingdom
Author contributions: Alkhatry M, Al-Rifai A, Annese V, Georgopolulos F, Jazzar AN, Khassouan AM, Koutoubi Z, Nathwani R, and Taha MZ discussed and voted the statements in two rounds of Delphi methodology; Limdi JK (native English) drafted and finalized the manuscript; All the authors have revised and approved the final version of the manuscript.
Supported by Emirates Gastroenterology and Hepatology Society, No. 001802.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vito Annese, MD, PhD, Assistant Professor, Director, Department of Gastroenterology, Valiant Clinic, City Walk 13th Street, Dubai, United Arab Emirates. vitoannese1@gmail.com
Received: April 16, 2020
Peer-review started: April 16, 2020
First decision: May 1, 2020
Revised: July 15, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: November 21, 2020
Processing time: 217 Days and 14 Hours
Abstract

Ulcerative colitis and Crohn’s disease are the main entities of inflammatory bowel disease characterized by chronic remittent inflammation of the gastrointestinal tract. The incidence and prevalence are on the rise worldwide, and the heterogeneity between patients and within individuals over time is striking. The progressive advance in our understanding of the etiopathogenesis coupled with an unprecedented increase in therapeutic options have changed the management towards evidence-based interventions by clinicians with patients. This guideline was stimulated and supported by the Emirates Gastroenterology and Hepatology Society following a systematic review and a Delphi consensus process that provided evidence- and expert opinion-based recommendations. Comprehensive up-to-date guidance is provided regarding diagnosis, evaluation of disease severity, appropriate and timely use of different investigations, choice of appropriate therapy for induction and remission phase according to disease severity, and management of main complications.

Keywords: Ulcerative colitis; Crohn’s disease; Infliximab; Adalimumab; Vedolizumab; Ustekinumab; Tofacitinib

Core Tip: The prevalence of ulcerative colitis and Crohn’s disease is on the rise. The advance in our understanding of the etiopathogenesis with an unprecedented increase in therapeutic options have changed the management towards tailoring evidence-based interventions. In this consensus, the diagnosis of inflammatory bowel diseases are based on the clinical evaluation and a combination of endoscopic, histological, radiological, and/or biochemical findings. The therapeutic options have been revised in view of the treatment goals, which now aim to treat beyond “symptoms” to achieve mucosal healing when possible and to minimize intestinal injury and bowel damage with resultant disability.